An update to the cost-effectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States

Figures & data

Figure 1. Structure of the model of prophylaxis for the prevention of IFD.

Table 1. Model parameters.

Model parameter	Estimate	Data source
Efficacy of prophylaxis
Probability of IFD with fluconazole/itraconazole	0.11	Cornely et al. (2007)7
Probability of IFD with posaconazole	0.05	Cornely et al. (2007)7
Survival following prophylaxis
Probability of IFD-related death, given IFD; posaconazole	0.36	Cornely et al. (2007)7
Probability of IFD-related death, given IFD; fluconazole/itraconazole	0.48	Cornely et al. (2007)7
Probability of other death within 100 days; posaconazole	0.14	Cornely et al. (2007)7
Probability of other death within 100 days; fluconazole/itraconazole	0.17	Cornely et al. (2007)7
5-year relative survival for AML patients after 100 days	0.249	Howlander et al. (2014)39
5-year relative survival for MDS patients after 100 days	0.176	Greenberg et al. (2012)40
Costs (2014 USD)
Mean IFD treatment costs	$47,890	HCUP-NIS analysis from 2007 inflation-adjusted to 201427^,41
Drug costs (per day)
Posaconazole tablet	$161	Data from Merck&Co.,Inc.
Fluconazole tablet	$5.31	Analysource database, data on file, Merck&Co.,Inc., 2014
Itraconazole oral suspension	$45.30	Analysource database, data on file, Merck&Co.,Inc., 2014
Mean duration of prophylaxis (days)
Posaconazole	29	Cornely et al. (2007)7
Fluconazole	24	Cornely et al. (2007)7
Itraconazole	29	Cornely et al. (2007)7
Discount rate	3%	Gold et al. (1996)46

IFD, invasive fungal disease; AML, acute myelogenous leukemia; MDS, myelodysplastic syndromes.

Table 2. Distributions and parameters used in the probabilistic sensitivity analysis.

Variable	Distribution	Parameters	Data source
Probability of IFD
Fluconazole/Itraconazole	Beta	a = 33, b = 265	Cornely et al. (2007)7
Posaconazole	Beta	a = 14, b = 290	Cornely et al. (2007)7
Probability of IFD-related death, given IFD
Fluconazole/Itraconazole	Beta	a = 21, b = 26	Cornely et al. (2007)7
Posaconazole	Beta	a = 21, b = 26	Cornely et al. (2007)7
Probability of other death within 100 days	Beta	a = 95, b = 507	Cornely et al. (2007)7
Mean duration of prophylaxis (days)
Posaconazole	Gamma	Mean = 29, SE = 1.20	Cornely et al. (2007)7
Fluconazole	Gamma	Mean = 24, SE = 1.03	Cornely et al. (2007)7
Itraconazole	Gamma	Mean = 29, SE = 2.80	Cornely et al. (2007)7
IFD treatment costs	Gamma	Mean = $47,890, SE = $3636	HCUP-NIS analysis from 2007 inflation-adjusted to 201427^,41

IFD, invasive fungal disease; HCUP-NIS, Healthcare Cost and Utilization Project-Nationwide Inpatient Sample; SE, standard error.

Table 3. Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of IFDs among high-risk neutropenic patients in the United States.

Analysis of 100-day clinical trial period (per patient results)
Treatment arm	Drug costs	IFD treatment costs	Total costs	Incremental costs	IFD events	IFD events avoided	ICER (IFD avoided)	Cost effective?
FLU/ITRA	$353	$5303	$5656	–	0.111	–	–	–
POS	$4673	$2205	$6879	$1222	0.046	0.065	$18,898	Yes
Analysis of lifetime model (per patient results)
Treatment arm	‘Tree’ costs	AML treatment costs	Total costs	Incremental costs	Life years	Life years saved	ICER (LYS)	Cost effective?
FLU/ITRA	$5,656	$0	$5656	–	2.68	–	–	–
POS	$6879	$0	$6879	$1222	2.86	0.184	$6,638	Yes

Figure 2. Probability that posaconazole is cost-effective vs fluconazole or itraconazole for the prevention of IFD among high-risk neutropenic patients.

Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007;356:348-59

 PubMed Web of Science ®Google Scholar

Howlader N NA, Krapcho M, Garshell J, et al, eds. SEER Cancer Statistics Review, 1975-2011. Bethesda, MD: National Cancer Institute, 2014

 Google Scholar

Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012;120:2454-65

 PubMed Web of Science ®Google Scholar

O’Sullivan AK, Pandya A, Papadopoulos G, et al. Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among neutropenic patients in the United States. Value Health 2009;12:666-73

 PubMed Web of Science ®Google Scholar

Coin News Media Group LLC. US Inflation Calculator. San Antonio, TX: Coin News Media Group LLC. 2014 [cited July 2014]; Available from: http://www.usinflationcalculator.com/

 Google Scholar

Gold MR, Siegel JE, Russell LB, et al, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996

 Google Scholar